The prevalence of vascular and metabolic complications after lung transplant in people with cystic fibrosis in a Dutch cohort

Oppelaar, Lisa M.; Luijk, Bart; Heijerman, Harry G.M.; Valk, Harold W. De; Meerkerk, Gerdien Belle-van

doi:10.1016/j.clinsp.2023.100274

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Sumário

Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100274 copy

The prevalence of vascular and metabolic complications after lung transplant in people with cystic fibrosis in a Dutch cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Cystic fibrosis related vascular complications.
Survival of people with cystic fibrosis.
Cystic fibrosis related vascular complications and metabolic complications.

Abstract

Background

With improvements in care for people with Cystic Fibrosis (pwCF), total survival after Lung Transplantation (LTx) will be longer. Therefore, this population's up-to-date analysis of late-onset post-transplant metabolic and vascular complications will be more relevant in current clinical practice.

Methods

We studied 100 pwCF who underwent an LTx between 2001 and 2020 at the University Medical Centre Utrecht, the Netherlands. The median age at transplant was 31 years and 55 percent was male. We assessed survival, the prevalence of metabolic complications (diabetes, renal damage, dyslipidemia, and metabolic syndrome), and vascular complications (hypertension, heart rhythm disease, micro-, and macrovascular disease). In addition, differences in risks for developing complications based on sex and overall survival were analyzed.

Results

The prevalence of macrovascular disease raised to 15.9 percent 15 years post-LTx. The prevalence of diabetes increased from 63 percent at LTx to over 90 percent 15 years post-LTx and the prevalence of dyslipidemia increased from 21 percent to over 80 percent. Survival 1-, 2-, 5-, and 10 years post-transplant were 84, 80, 76, and 58 percent respectively. No significant differences were found based on sex.

Conclusion

This study shows that the prevalence of cardiovascular risk factors increases after LTx for CF, potentially leading to major complications. These data emphasize the necessity of regular check-ups for metabolic and vascular complications after LTx with specific attention to renal damage. Early recognition of these complications is crucial and will lead to earlier intervention, which could lead to improved prognosis after lung transplantation.

Keywords
Cystic fibrosis; Lung transplant; Vascular disease; Metabolic disease; Diabetes; Renal insufficiency

	Number of subjects available for analysis			Total cohort ^a a n (%) for specified conditions. For continuous variables the median was shown.	Male	Female	p-value
	Male	Female	Total		n (%)	n (%)
Hypertension	55	45	100	4 (4%)	2 (3.6%)	2 (4.4%)	1.0
Cystic fibrosis-related diabetes	55	45	100	63 (63%)	32 (58.2%)	31 (68.9%)	0.3
Renal insufficiency	55	45	100	3 (3%)	1 (1.8%)	2 (4.4%)	0.6
Dyslipidemia	34	23	57	12 (21.1%)	6 (17.6%)	6 (26.1%)	0.5
Metabolic syndrome	47	38	85	2 (2.4%)	0 (0%)	2 (5.3%)	0.2
Microvascular complications	51	44	95	1 (1.1%)	0 (0%)	1 (2.3%)	0.5
Macrovascular complications	51	43	94	1 (1.1%)	0 (0%)	1 (2.3%)	0.5
Heart rhythm disease	43	37	80	10 (12.5%)	4 (9.3%)	6 (16.2%)	0.5
Median age at LTx	55	45	100	31.0	35.0	28.0	0.047^b b p-value showed statistical significance: p ≤ 0.05
Median body mass index	53	44	97	19.7	19.7	19.7	0.4

	Number of subjects available for analysis		Male (n = 55)	Female (n = 45)	Hazard Ratio Age-adjusted	95% Confidence Interval Age-adjusted
	Male	Female	n (%)	n (%)
Hypertension	55	45	30 (54.5%)	26 (57.8%)	1.03	0.5‒2.2
New onset diabetes after LTx	55	45	13 (23.6%)	11 (24.4%)	1.58	0.6‒4.5
Total diabetes after LTx	55	45	46 (83.6%)	43 (95.6%)	1.22	0.7‒2.1
Renal insufficiency	55	43	14 (25.5%)	20 (46.5%)	2.77^a a Trends toward significance.	0.93‒8.3
Dyslipidemia	47	38	34 (72.3%)	34 (89.5%)	1.43	0.7‒3.0
Metabolic syndrome	46	38	20 (43.5%)	27 (71.1%)	1.86	0.8‒4.2
Microvascular disease	44	35	14 (31.8%)	14 (40.0%)	1.07	0.3‒3.1
Macrovascular disease	44	38	3 (6.8%)	10 (26.3%)	51.92	0.1‒44986
Heart rhythm disease	54	43	13 (24.1%)	14 (32.6%)	0.92	0.3‒2.5

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[1] ⁎ Corresponding author. E-mail address: (L.M. Oppelaar).